70 Years After the Guadalcanal Campaign: The Solomon Islands, from Plantation to Nation

Healthcare

Access to healthcare in the Solomon Islands is a problem unique to an island nation made up of more ocean than landmass. Providing access to care for a population spread out over hundreds of islands is a herculean task that has yet to be mastered. The majority of healthcare is funded by the Solomon Island Government with external assistance from AusAID, JICA and Taiwan.  Private health insurance has begun to appear in the Solomon Islands, paid for by employers like the Gold Ridge Mine and Guadalcanal Plains Palm Oil Limited (GPPOL). The Ministry of Health along with AusAID and the World Bank oversee the administration of health care programs through a Sector Wide Assistance Program (SWAp). There are hundreds of village outpost clinics, seven provincially located secondary hospitals, four faith-based private hospitals and one main tertiary care hospital located on Guadalcanal, the National Referral Hospital (NRH). Constructed in the 1960s NRH is known locally as “number nine” as it was built on the site where the Ninth Army Field hospital operated during WWII. NRH is where all specialty care including complex obstetrics and surgery are provided for the entire country. The harsh tropical weather has taken its toll on the hospital’s infrastructure leaving some of the wards devoid of running water, subject to leaking roofs and periodic electric outages. The services available are modest with physicians and nurses provide care under conditions so challenging that most developed country health care workers would surrender to. In the outer islands where 80% of the population lives provincial hospitals have limited staffing, equipment and skills. JICA recently completed construction of a new hospital in Gizo, the country’s second largest town. It replaced the hospital that was badly damaged during the 2007 tsunami. This project sparked debates among the international donors about the appropriateness of building a hospital versus a hotel that could have contributed to local economic development and commerce.

The Solomon Islands greatest health challenges remain malaria and childhood infections. There have been modest gains in achieving the Millennium Development Goals addressing childhood and maternal mortality but domestic violence rates of 65% persist and a lack of empowerment for women remains a problem. The incidence and prevalence of HIV/AIDs is not known as cultural and religious influences have resulted in under-testing for the disease. But it is estimated, based on rates of sexually transmitted diseases and extrapolation of the prevalence of HIV/AIDs in neighboring Papua New Guinea, to be around 1%.  While USAID funds health system strengthening for HIV/AIDS awareness in Papua New Guinea it does not currently fund health care development of any kind in Solomon Islands.

US relations

In 1960, President-elect John F. Kennedy invited Biuku Gasa and Eroni Kumana, the two Solomon Island men who rescued him during WWII to his inauguration. Unfortunately they were unable to travel to Washington, DC to see the giant model of JFK’s PT-109 boat go down Constitution Avenue because of visa problems. But they never forgot him and on Ranongga Island there is a shrine to Kennedy. When JFK was assassinated all of the western Solomon Islands felt the loss of their young Navy Lieutenant who went on to become President of the most powerful country in the world. The connection to the United States remains strong today despite what has been referred to as a policy of “benign neglect.” Following the 2010 high level State Department visit by Assistant Secretary of State Kurt Campbell the local Solomon Island newspaper’s headline read: “Good to have you back US!”

When USAID closed it Pacific Island Regional office in 1994 due to budgetary constraints and the Peace Corp evacuated the Solomon Islands in 2000 during the civil unrest, formal US relations with the country nearly ended. United States government funded aid programs trickled to a paltry $224,000 US over a ten-year period.  But during that time United States diplomatic ties were kept alive by the presence of a Consular Agent in Honiara and by American civilian organizations and non-government agencies. The Obama Administration’s commitment to re-engaging in the Pacific Region has rekindled United States relations with the Solomon Islands. With the reopening of the USAID Pacific Islands Regional Office in Port Moresby, Papua New Guinea in October 2011, USAID is now funding development assistance programs in the region. These include the Coral Triangle Initiative (CTI) a multilateral partnership between Solomon Islands, Papua New Guinea, the Philippines, Timor Leste, Indonesia and Malaysia. CTI cooperatively works toward protecting and sustaining the extraordinary marine and coastal resources in the Pacific triangle area by addressing crucial issues such as food security, climate change and marine biodiversity. The US government has allocated $66 million for this 5-year program. An additional $21 million has been pledged towards addressing climate change in the Pacific Region. On Guadalcanal the United States also oversees a program that addresses the large number of dangerous and unstable, unexploded WWII ordinances located on Guadalcanal and in the waters around the islands.

There is no doubt that rising concerns about China’s influence both militarily and economically in the Pacific have peaked the hegemonic interests of the United States and perhaps it is for these reasons USAID funding has returned to the region. China’s expansion throughout the Pacific Islands through trade and procurement of natural resources along with a build up of it’s military forces is seen by some as an eerie doppelganger of pre-WWII Pacific history.  In a twist of irony the Trans-Pacific Partnership (TPPA) a pluri-lateral free trade agreement being pushed by the Obama administration needs Japan’s participation in order to offset China’s economic strength in the region. Japans involvement in TTPA will allow it to cover 40% of the global GDP solidify Washington’s political, financial and military commitment to the Pacific Region. What impact the Trans-Pacific Partnership will have on the Pacific Island Nations like Solomon Islands is unclear.  Solomon Islands and other small Pacific economies, if not a part of TPPA, could be vulnerable to worsening exploitation of natural resources by privileged international investors. For this reason perhaps the United States should make provisions for the 16 Pacific Island Nations to be included in TTPA. Negotiations between TTPA, the Pacific Island Forum (PIF) and the Melanesian Spearhead Group (MSG) are needed, as most of these countries individually are ill equipped to develop their economies to scale with the larger economies.

As a physician and global health advocate this author’s greatest concern for the Solomon Islands is for the immediate fate of the post-graduate training of fifty Solomon Island students currently studying medicine in Cuba. These are some of the country’s best and brightest young people and they will return to Solomon Islands in 2013 when their studies are completed. At present there are no post-graduate training programs in place for them and this precious resource is at great risk of going to waste. Targeted assistance from programs similar to the National Institutes of Health and PEPFAR’s Medical Education Partnership Initiative (MEPI) will allow United States medical professionals to work side by side with medical professionals in the Solomon Islands on education, research and training in order to improve the delivery of health care, retain doctors and nurses locally and solve the country’s health care workforce shortage using sustainable solutions. Without this type of training these new doctors are at risk of abandoning health care for taxicab driver jobs or leaving the country to seek medical employment elsewhere.

As the United States moves forward to set the stage for it’s new engagement in the Pacific Region over the next 70 years, we must be mindful of the bipartisan and historic legacy that has shaped our relationship with countries like the Solomon Islands over the past 70 years. We must never forget the sons, brothers, fathers and uncles who as US servicemen in the Pacific Region never came home or the local people who assisted them.

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